To the Editor：Despite of the rapid increase of donation after cardiac death （DCD） in China, the shortage of organs continues to be a major problem. Every organ procured is so valuable that it should never be discar...To the Editor：Despite of the rapid increase of donation after cardiac death （DCD） in China, the shortage of organs continues to be a major problem. Every organ procured is so valuable that it should never be discarded easily, especially a liver that could save a patient＇s life in an emergency. This leads to the use of grafts from donors with unrecognized Here and unusual diseases, including schistosomiasis. we reported a case of orthotopic liver transplantation （OLT） from a donor with Schistosorna japonicurn to a patient with end-stage cirrhosis due to HBV infection.展开更多
To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,in...To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,infection,autoimmune disorders,blood-group incompatible展开更多
To the Editor:Worldwide,approximately 400 million patients have chronic hepatitis B virus(HBV)infection[1].Because of the high incidence of HBV in China,the incidence of HBV infection in uremia and kidney transplantat...To the Editor:Worldwide,approximately 400 million patients have chronic hepatitis B virus(HBV)infection[1].Because of the high incidence of HBV in China,the incidence of HBV infection in uremia and kidney transplantation(KTx)patients is 2.5%and 2.7%,respectively[2].Since the first successful organ transplant conducted between twins in 1954,refined surgical techniques,improved immunosuppressive protocols,and improved perioperative management of transplant patients have resulted in improved patient and graft survivals following K Tx[3].However,the K Tx community is now challenged with liver failure due to the increased risk of HBV viral activation and replication induced by immunosuppressive therapy.Harnett et al.[4]highlighted that KTx recipients with HBV infection had lower 5-year survival(61%)than patients on dialysis(85%).Although these KTx recipients were treated with regular anti-HBV therapy,the incidence of liver failure was increased in KTx patients with HBV infection.Currently,isolated liver transplantation(LTx),sequential liver and kidney transplantation(SLKT),and combined liver and kidney transplantation(CLKT)are the optimal treatments for patients with liver failure and hepatorenal syndrome[5].However,the outcomes of KTx recipients following isolated LTx,SLKT or CLKT for HBV-associated liver failure remain to be studied.Herein,we report our experience in ten HBV-positive KTx recipients with liver failure undergoing LTx.展开更多
BACKGROUND:The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications,including outflow obstruction and Budd-Chiari syndrome.Th...BACKGROUND:The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications,including outflow obstruction and Budd-Chiari syndrome.The aim of this study is to clarify the anatomy and variations of hepatic veins(HVs)draining into the inferior vena cava(IVC),and to classify the surgical techniques of piggy-back liver transplantation(PBLT)based on the anatomy of HVs which can reduce the occurrence of complications.METHODS:PBLT was performed in 248 consecutive cases at our hospital from January 2004 to August 2011.The anatomy of recipients’HVs was determined when removing the native diseased livers.Both anatomy of HVs and short HVs draining into the IVC were recorded.These data were collected and analyzed.RESULTS:We classified anatomic variations of HVs in the 248 livers into five types according to the way of drainage into the IVC:type I(trunk type of left and middle HVs),142(57.3%)patients;type II(trunk type of right and middle HVs),54(21.8%);type III(trunk type of left,middle and right HVs),14(5.6%);type IV(non-trunk type of left,middle and right HVs),of which,type IVa,16(6.5%),in the same horizontal plane;type IVb,18(7.3%),in different horizontal planes;and type V(segment type),4(1.6%).The patients whose HVs anatomy belonged to types I,II and III underwent classical piggy-back liver transplantation.Type IVa patients had classical PBLT via HV venoplasty prior to piggy-back anastomosis,while type IVb patients and type V patients could only have modified PBLT.CONCLUSION:This study demonstrates that HVs can be classified according to the anatomy of their drainage into the IVC and we can use this classification to choose the best operative approach to PBLT.展开更多
基金supported by a grant from the Wu Jieping Medical Foundation(320.6750.15070)
文摘To the Editor：Despite of the rapid increase of donation after cardiac death （DCD） in China, the shortage of organs continues to be a major problem. Every organ procured is so valuable that it should never be discarded easily, especially a liver that could save a patient＇s life in an emergency. This leads to the use of grafts from donors with unrecognized Here and unusual diseases, including schistosomiasis. we reported a case of orthotopic liver transplantation （OLT） from a donor with Schistosorna japonicurn to a patient with end-stage cirrhosis due to HBV infection.
基金supported by a grant from the Natural Science Foundation of Hunan Province(2016JJ4105)
文摘To the Editor:Hemolysis,which is caused by a variety of immune and non-immune mechanisms,is a well-recognized complication of solid organ transplantation.;Hemolysis post-liver transplantation can be induced by drug,infection,autoimmune disorders,blood-group incompatible
基金the National Natural Science Foundation of China(81771722).the Ethics Committee of the Third Xiangya Hospital of Central South University(No.2020-S024).
文摘To the Editor:Worldwide,approximately 400 million patients have chronic hepatitis B virus(HBV)infection[1].Because of the high incidence of HBV in China,the incidence of HBV infection in uremia and kidney transplantation(KTx)patients is 2.5%and 2.7%,respectively[2].Since the first successful organ transplant conducted between twins in 1954,refined surgical techniques,improved immunosuppressive protocols,and improved perioperative management of transplant patients have resulted in improved patient and graft survivals following K Tx[3].However,the K Tx community is now challenged with liver failure due to the increased risk of HBV viral activation and replication induced by immunosuppressive therapy.Harnett et al.[4]highlighted that KTx recipients with HBV infection had lower 5-year survival(61%)than patients on dialysis(85%).Although these KTx recipients were treated with regular anti-HBV therapy,the incidence of liver failure was increased in KTx patients with HBV infection.Currently,isolated liver transplantation(LTx),sequential liver and kidney transplantation(SLKT),and combined liver and kidney transplantation(CLKT)are the optimal treatments for patients with liver failure and hepatorenal syndrome[5].However,the outcomes of KTx recipients following isolated LTx,SLKT or CLKT for HBV-associated liver failure remain to be studied.Herein,we report our experience in ten HBV-positive KTx recipients with liver failure undergoing LTx.
文摘BACKGROUND:The piggy-back caval anastomosis technique is widely used in orthotopic liver transplantation although it carries an increased risk of complications,including outflow obstruction and Budd-Chiari syndrome.The aim of this study is to clarify the anatomy and variations of hepatic veins(HVs)draining into the inferior vena cava(IVC),and to classify the surgical techniques of piggy-back liver transplantation(PBLT)based on the anatomy of HVs which can reduce the occurrence of complications.METHODS:PBLT was performed in 248 consecutive cases at our hospital from January 2004 to August 2011.The anatomy of recipients’HVs was determined when removing the native diseased livers.Both anatomy of HVs and short HVs draining into the IVC were recorded.These data were collected and analyzed.RESULTS:We classified anatomic variations of HVs in the 248 livers into five types according to the way of drainage into the IVC:type I(trunk type of left and middle HVs),142(57.3%)patients;type II(trunk type of right and middle HVs),54(21.8%);type III(trunk type of left,middle and right HVs),14(5.6%);type IV(non-trunk type of left,middle and right HVs),of which,type IVa,16(6.5%),in the same horizontal plane;type IVb,18(7.3%),in different horizontal planes;and type V(segment type),4(1.6%).The patients whose HVs anatomy belonged to types I,II and III underwent classical piggy-back liver transplantation.Type IVa patients had classical PBLT via HV venoplasty prior to piggy-back anastomosis,while type IVb patients and type V patients could only have modified PBLT.CONCLUSION:This study demonstrates that HVs can be classified according to the anatomy of their drainage into the IVC and we can use this classification to choose the best operative approach to PBLT.
